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Is Equine Rhinitis Virus Associated with Inflammatory Airway Disease In IS EQUINE RHINITIS V IRUS ASSOCIATED WITH INFL AMMATORY AIRWAY DISEASE IN HO RSES? A MAJOR QUALIFYING PROJECT SUBMITTED TO THE FAC ULTY OF WORCESTER POLYTECHNIC INSTITUTE IN PARTIAL FULFILLMENT OF THE R EQUIREMENTS FOR THE DEGREE OF BACHELOR O F SCIENCE By: Brenna Pugliese (Biology/Biotechnology) Margaret Wigley (Biology/ Biotechnology) On: April 25, 2013 WPI Faculty Advisor: Jill Rulfs TCSVM Veterinary Advisor: Dr. Melissa Mazan, DVM, DACVIM Pugliese, Wigley 2 CONTENTS Table of Figures .......................................................................................................................................................................... 3 INTRODUCTION ......................................................................................................................................................................... 6 Inflammatory Airway Disease ......................................................................................................................................... 6 Virology ..................................................................................................................................................................................... 8 Bronchoaveolar Lavage .................................................................................................................................................... 16 Open Plethysmography .................................................................................................................................................... 20 Works Cited ................................................................................................................................................................................ 27 Introduction ............................................................................................................................................................................... 29 Materials and Methods .......................................................................................................................................................... 31 Bronchoalveolar Lavage .................................................................................................................................................. 31 Inclusion Criteria ................................................................................................................................................................ 32 Forced Oscillatory Mechanics ........................................................................................................................................ 32 Statistical Analysis .............................................................................................................................................................. 34 Results .......................................................................................................................................................................................... 35 Discussion ................................................................................................................................................................................... 38 Works Cited ................................................................................................................................................................................ 43 Pugliese, Wigley 3 TABLE OF FIGURES Figure 1: BAL tubing with inflation cuff (Tufts).......................................................................................................... 17 Figure 2: BAL set-up in equine patient. (Tufts) ........................................................................................................... 18 Figure 3: Bronchoalveolar cytology (1000xmag, Wright Giemsa stain). (a) An alveolar macrophage (AM) and a darkly granulated mast cell (MC) are shown in a sample from a normal horse. (b) From a horse with exercise induced pulmonary hemorrhage, a typical haemosiderin-laden macrophage (haemosiderophage HSP) and lymphocyte (L). (c) In a horse with marked small airway inflammatory disease is shown neutrophils (PMN), mast cells (MC) and an alveolar macrophage (AM). (d) An eosinophil (EOS) and alveolar macrophage in a normal horse. (e) Fibrillar mucus containing predominantly neutrophils was recovered from a horse with COPD. (Hoffman A. M., 1999). ........................................................................................................................................................................................... 19 Figure 4: Facemask and pneumotachograph on an equine patient during lung function testing. ........ 25 Figure 5: Placement of respiratory inductance bands on artificial horse. ....................................................... 25 Figure 6: Mean polymorphonuclear leukocyte, mast cell, and eosinophil count obtained from BAL fluid analysis. Black bar indicates sample mean. Control n=9, affected n=25………………………………… 34 Figure 7: Histamine challenge in Necco, an equine patient diagnosed with IAD. Linear fit performed………………………………………………………………………………………………………………………….……....37 Pugliese, Wigley 4 ACKNOWLEDGEMENTS Dr. Melissa Mazan, DVM, DACVIM Dr. Daniela Bedenice, DVM, DACVIM, DACVECC Tufts Cummings School of Veterinary Medicine Hospital for Large Animals Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis Dr. Elizabeth Ryder, A.B., M.S., Ph.D. Pugliese, Wigley 5 ABSTRACT We conducted research at Tufts Cummings School of Veterinary Medicine investigating equine rhinitis virus (ERV) as the cause of IAD exacerbations in horses. To identify patients with IAD, histamine bronchoprovocation and cytological analysis of bronchoalveolar lavage fluid (BALF) was used to quantify airway hyperreactivity and inflammation. The prevalence of ERV and other equine respiratory viruses was determined via the RT-PCR of lung fluid samples and serology of blood samples. We hope this will be a step forward in equine pulmonology. Pugliese, Wigley 6 INTRODUCTION Inflammatory airway disease (IAD) is a prevalent respiratory illness affecting young equine athletes. Much remains unknown about this disease and its clinical symptoms and causes. Though it is known that stable environment plays a major role in the development of IAD, little is known about the correlation between IAD and common respiratory viruses. We hypothesize that exacerbation/initiation of inflammatory airway disease in horses is associated with Equine Rhinitis Virus (ERV) infection. Our goal was to determine whether horses with an exacerbation of IAD had been recently infected with equine rhinitis virus or other related equine respiratory viruses. To accomplish this goal, pulmonary function testing was performed in combination with bronchoalveolar lavage to identify horses with IAD. In order to isolate identify viral pathogens, cells and fluid from bronchoalveolar samples were analyzed using polymerase chain reaction (PCR). Furthermore, blood samples were collected and processed to detect antibody response to these viral pathogens which would indicate recent exposure and/or infection. Determining an association between viral infections and IAD has larger implications for both equine and human health. IAD in an equine patient is akin to asthma in a human patient, and furthermore, human rhinovirus is known to cause exacerbation of asthma. Evidence to support the hypothesis that equine viral infections are associated with exacerbations of IAD will contribute to the understanding of respiratory disease in both equine and human populations. INFLAMMATORY AIRWAY DISEASE Respiratory disease is a problem worldwide in horses of all ages and occupation (Couetil, 2002). Older horses commonly experience respiratory problems, and a multitude of studies have been done to determine the various causes. Recently, it has become apparent that young horses also experience airway inflammation with no known cause (Hodgson, 2002). Research on respiratory problems in young horses is limited; focusing mainly on more common equine diseases in older horses. In 2002, a broad definition was applied to horses with nonspecific inflammation that were exhibiting exercise intolerance. This condition was termed inflammatory airway disease or IAD (Laurent L. Couetil, 2007). Pugliese, Wigley 7 IAD is not completely understood, as its etiology, inflammation and type of inflammatory cell are unknown (Hodgson, 2002). There is no universally accepted definition of IAD, but in general it is commonly seen in younger racehorses. In many cases the only indication of disease will be reduced exercise tolerance or poor performance. In other cases, there is chronic inflammation, mild airway obstruction, bronchitis or bronchiolitis, overproduction of mucus and the presence of cough. In most cases, there is a pool of mucus at the tracheal inlet or a continuous stream (K. J. Allen, 2006). The proposed minimum criteria for IAD diagnosis is poor performance or exercise intolerance, airway hyper-responsiveness, and/or impaired gas exchange at rest (Laurent L. Couetil, 2007). Of all the symptoms, cough is the most subjective when diagnosing IAD. In 2002, it was found that cough was only present in 38% of horses with IAD, yet 85% of horses with a cough were diagnosed with IAD (Couetil, 2002). Cough seems to be correlated with the amount of mucus production in both the upper and lower airways (Kanichi Kusano, 2008). Cough does not have to be present for diagnosis.
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